1. CHAPTER 11: Working with Selected Populations: Treatment Issues and Characteristics
Substance Abuse Counseling: Theory and Practice
Fifth Edition
Patricia Stevens
Robert L. Smith
Prepared by:
Dr. Susan Rose, University of the Cumberlands

2. Overview of Chapter Children and Adolescents Women
The Gay/Lesbian/Bisexual/Transgender Community
People with Disabilities
Older Adults
Homelessness

3. Children and Adolescents
Key risk periods for drug abuse occur during major transitions
Vulnerable life periods are transitions
Moving from one developmental stage to another
First major transition for children is when they leave the security of the family and enter school
Next is when they advance from elementary to middle school
It is at this stage (early adolescence) that children are likely to encounter drug use for the first time
Next is entering high school
Greater exposure to available drugs, drug users, and social activities involving drugs
Life changes
Moving
Parents divorcing

4. Children and Adolescents
Research indicates that signs of risk can be seen as early as infancy or early childhood, including:
Aggressive behavior
Lack of self control
Difficult temperament
Family situations also increase a child’s risk for later drug abuse when there is:
A lack of attachment and nurturing by parents and caregivers
Ineffective parenting
A caregiver who abuses drugs

5. Children and Adolescents
Research suggests that conduct disorders and other behavioral and temperament traits that increase a youth’s vulnerability to drug use develop as a fairly stable pattern as early as 5 years of age.
Characteristics of these children
Impulsivity
Attention Deficit Disorder
Difficult temperament
Below-average verbal IQ
Academic underachievement
Negative affect
Difficulties with emotional regulation
Social incompetence
Aggression

6. Children and Adolescents
Risk
Factors
Community
School
Peer
Family
Individual

7. Children and Adolescents
Individual Risk Factors:
Early and persistent behavior problems such as stealing, vandalism, conduct disorder, atttention-deficit hyperactivity disorder (ADHD), rebelliousness, and aggressiveness, particularly in boys
High-risk personality factors such as sensation seeking, low harm avoidance, and poor impulse control
Low self-esteem
Deficits in behavioral-affective regulation
Antisocial behaviors
Alienation
High tolerance for deviance and strong need for independence
Psychopathology
Attitudes favorable to drug use

8. Children and Adolescents
Family Risk Factors
Low parental involvement
Family history of alcohol or drug use
Poverty
Parental substance use and modeling
Poor family management and parenting practices
Poor parent-child relationships
Family conflict
Physical and sexual abuse
Peer Risk Factors
Negative peer influence
Peer influence; peer rejection or low acceptance

9. Children and Adolescents
School Risk Factors
Low commitment to school/lack of school bonding
School failure
Failure to achieve in school
Low school involvement
Negative school involvement
Community Risk Factors
Lack of social competence
Community and interpersonal violence
Deficient cultural and social norms
Neighborhood disorganization that reduces the sense of community

10. Children and Adolescents
Important goal of prevention is to change the balance between risk and protective factors.
Most frequently identified protective processes
Parent-child attachment
Parental supervision
Communication of family values
Second-most important socializing agent for children, after the family, is the school.
School-bonding and achievement are critical protective factors.

11. Children and Adolescents
Factors which were found to increase resiliency:
Optimism and hope
Self-efficacy
Strong self-regulation skills
Problem-solving skills
Adaptability
Self-regulation
Sense of humor
Easy temperament
Close relationship among family members
Low discord between parents
Warm and structured parenting style

12. Children and Adolescents
Prevention and Intervention
Family support programs that encourage involvement of the parents in their children’s lives
Prevention programs designed to increase positive peer relationships
School Prevention Programs should be integrated within the school’s own goals of increasing academic performance and should focus on:
Improving academic and social-emotional learning to address risk factors for drug abuse
Support for positive peer relationships
Education component designed to correct the mispercetion that most students are using drugs

13. Children and Adolescents
Meeting adolescent specific needs
Steps
Initial screening
In-depth assessment covering:
Psychological and medical problems
Learning disabilities
Family functioning
Other aspects of youths’ lives
Treatment program

14. Women
Risk Factors
Agrawl reports that women (18-49 years of age) who are married have a lower rate of substance abuse or dependence than unmarried women
History of divorce is positively associated with illicit drug use, not dependence.
Partners can influence each other’s drinking and drug use.
Women are more likely than men to have co-occurring mental and substance use disorders.
Affects on pregnant women
Alcohol is the most common cause of malformation to the embryo or fetus in pregnancy.

15. Women Prevention and Intervention
Reports concerning treatment of women have shown:
Women experience a number of barriers to receiving treatment, including:
Child Care
Stigmatization
Inability to pay for treatment
Women are more vulnerable than men to some of the physiological effects of substance abuse
Substance abuse among women is more often rooted in psychosocial problems and traumatic life events

16. Women Protective Factors Parental Warmth Spousal or Partner Support
Spiritual Presence
Coping Skills

17. The Gay/Lesbian/Bisexual/ Transgender Community
Gay/Lesbian/Bisexual/Transgender Identity Development
“Coming Out”
Assumptions of Cass’s Model
Identity is acquired through a developmental process
Change in behavior stems from the interaction between individuals and their environment
Stages of Identity Development
Identity confusion
Identity comparison
Identity tolerance
Identity acceptance
Identity pride
Identity synthesis

18. The Gay/Lesbian/Bisexual/ Transgender Community
Risk Factors
Prejudice and discrimination
Cultural issues
Legal issues
Accessibility
Families of origin
Health issues
Gay bars
Treatment is the same as that for other individuals
However, some GLBT clients will need to address their feelings about their sexual orientation as a part of their recovery

19. People with Disabilities
Risk Factors
Substance abuse behaviors need to be identified as to whether they are a consequence of, or a response to, the disabling event.
Contributing factors
Stress
Crisis
Loss and Grief
Body Image
Sigma

20. People with Disabilities
Risk Factors cont.
Most frequently experienced psychosocial reactions to a disability that affect one’s ability to cope:
Shock
Anxiety
Denial
Depression
Anger/Hostility

21. People with Disabilities
Prevention and Intervention
Substance abuse treatment for people with disabilities should include the following:
Family psychoeducation
Disability and medication management and education
Independent living skills education
Anger and stress management
HIV risk reduction, counseling, and testing
STD and infectious disease education
Interpreted self-help meetings for the deaf and hard of hearing
Health and wellness education
Case management and crisis intervention
Educational, Vocational, and residential referrals
Medical and psychiatric services
Domestic violence and victim assistance counseling
Development of social support networks
Self-esteem and body image

22. Older Adults Risk Factors
Various biological, psychological, and social that accompany aging make older adults uniquely vulnerable to problems associated with substance abuse, including:
Loneliness
Diminished mobility
Impaired sensory abilities
Chronic pain
Poor physical health
Poor economic and social supports
Social stigma
Change in social support and work-related activities
Loss
One in four older adults have a significant mental disorder.

23. Older Adults Prevention and Intervention
Research supports including the following into substance abuse treatment for older adults:
Age-specific group treatment that is supportive and nonconfrontational with focus on self-esteem building
Coping with depression, loneliness, and loss
Rebuilding the client’s social support network
Pace and content of treatment appropriate for the older person
Staff members who are interested and experienced in working with older adults
Linkages with medical services, services for the aging, institutions for treatment, and case management
Kinney stresses the importance of groups in substance abuse treatment for older adults.

24. Homelessness
An estimated 20%-25% of homeless people have a serious mental illness
One-half has an alcohol or drug problem.
Cause/Effect debate
Risk Factors
Four main groups that often suffer from homelessness and its effects:
Families
Youth
Veterans
Chronic Homelessness

25. Homelessness Treatment
When homeless individuals feel humanized and treated with respect, they are more receptive to treatment services.
Another important factor in successful abuse treatment is housing.